The Importance of Bone Health With MS

bone health and multiple sclerosis

Make No Bones About It!!

Bone health is very important! They do a lot for us: protect our vital organs, anchor our muscles and bank minerals like magnesium and calcium to ensure the body is able to maintain the proper levels required for functions such as normal heart rhythm, muscle contraction, nerve function and more.

There are some risk factors for osteoporosis that are not modifiable such as age, gender and family history. But there are changes we can make to our habits and behaviors to reduce our risk. These include:

  • Kick the smoking habit
  • Don’t consume alcohol in excess
  • Maintain a Healthy Weight. Older adults who are overweight have a higher risk for falling. Being underweight raises the risk of bone loss.
  • Adopting a more active lifestyle that includes weight bearing exercise
  • Eat a more nutrient dense diet rich in the vitamins and minerals required either directly or indirectly to build bone. I wrote about the “bone bank” in this article and discussed how the balance changes over time and depends heavily on us to make regular nutrient “deposits” with the foods that we eat.

If we fail to do out part to maintain our bones then we are at greater risk of developing osteoporosis.


Is there a Connection Between MS & Osteoporosis?

Research suggests that Multiple Sclerosis is associated with a decreased bone mineral density which contributes to a greater risk for developing osteopaenia which is bone density that is not normal but also not as low as osteoporosis. Osteoporosis  is  a thinning of the bones, with reduction in bone mass, due to depletion of calcium and bone protein or bone fractures. The more progressive the disease, the more severe the bone loss.  There are a number of possible explanations for low bone mineral density in individuals with MS;

  • The impact of pro-inflammatory cytokines and chronic inflammation associated with the MS disease process
  • Progressive disability, immobility, lack of weight bearing physical activity
  • Impaired balance and gait control which can lead to increased falls. When this is combined with low bone mineral density, increased fractures can result.
  • Long term glucocorticoid use ( greater than 3-4 months) can result in weakened bones.
  • Long term use of certain anti-depressants
  • A diet deficient in vitamin D, Calcium and other vital nutrients


Prevention is more effective than treatment of established osteoporosis

Two important things you can do to improve your bone health with MS:

#1 Move Your Body to Strengthen Your Bones!

Exercise is a very important part of keeping your bones strong. Weight bearing exercises apply a mechanical stress to the bones which provides them with the workout they need to stay strong.  Good forms of exercise include:

  • hiking, dancing, jogging, tennis, and climbing stairs are examples of high impact weight bearing exercises.
  • using an elliptical trainer, a treadmill or taking a walk are good examples of low impact weight bearing exercises
  • lifting weights or using elastic exercise bands to improve strength
  • tai chi or yoga to increase muscle strength and improve balance

Consult your MD before starting a new exercise regimen. Check out the links below for more information about exercising with MS.


  • I have had a number of people tell me that they think exercise will be difficult and require a lot of special equipment or routines. This great resource from MS Active Source  demonstrates that physical activity does not have to be too terribly complicated. Check it out!
  • Can Do MS : They offer a lot of information on MS topics as well as a webinar series on a variety of topics including exercise.
  • is a great resource! They provide ” practical information on how to stay active (physically, intellectually, and socially)—when traveling, playing in the outdoors, exercising, or just plain enjoying life—regardless of our disease and the sometimes devastating symptoms it throws at us.” There are  lot of tips and considerations for specific exercises. There is downloadable information available here as well.
  • The National MS Society offers some additional information about exercising with MS.


#2 Feed Your Body to Feed Your Bones!

Eating empty calories will not be good for your body or your bones. Opt for nutrient dense foods as much as possible. Calcium and Vitamin D are well known for the important role they play in building strong bones. The skeleton is our body’s major storage bank for calcium, and Vitamin D helps our bodies effectively absorb calcium from our diets.

Foods rich in calcium include: Milk, Yogurt, Cheese, Fortified Soy & Almond Milk, Sardines, Tofu, Kale, Cooked Spinach

Foods rich in vitamin D include: Fatty Fish, Eggs, Mushrooms, Fortified Cows and Non Dairy Milks, Fortified Foods


But did you know that there are a number of other nutrients that play important supporting roles?

Protein– provides the building blocks for hormones and growth factors involved in bone synthesis.

Protein rich foods include: Meat, Poultry, Eggs, Dairy, Yogurt, Beans, Lentils, Nuts, Seeds, Tofu, Tempeh

Zinc– is involved in enzyme reactions and collagen synthesis.

Zinc rich foods include: Sesame Seeds, Pumpkin Seeds, Lentils, Garbanzo Beans, Cashews, Quinoa, Beef, Lamb, Turkey, Shrimp

Copper is involved in enzyme reactions that are involved in bone formation and  mineralization.

Copper rich foods include: Sesame Seeds, Kale, Cashews, Soybeans, Shitake Mushrooms, Tempeh, Garbanzo Beans, Lentils, Lima Beans, Walnuts,Pineapple

Manganese–  is an important cofactor for several enzymes in bone tissue. 

Manganese rich foods include: Oats, Brown Rice, Garbanzo Beans, Strawberries, Spinach, Rye, Soybeans, Bok Choy, Collards, Cloves

Iron– is a cofactor for enzymes involved in collagen synthesis as well as being involved in transforming inactive vitamin D to the active form which helps to improve Calcium absorption.

Iron rich foods include: Beef, Chicken, Fish, Oysters, Organ Meats, Lentils, Beans, Soybeans, Dried Fruits, Tofu, Enriched or Fortified Grain Products


Vitamin K-is an enzyme reaction cofactor.

Foods rich in Vitamin K include: Kale, Spinach, Mustard Greens, Collards, Turnip Greens, Parsley, Broccoli, Brussels Sprouts

Vitamin C– is an enzyme reaction cofactor.

Foods rich in Vitamin C include: Pineapple, Kiwi, Citrus, Cabbage, Leafy Greens, Bell Peppers, Strawberries, Cauliflower, Cantaloupe, Papaya, Fennel

Vitamin A– is essential to the bone building process.

Foods rich in vitamin A (carotenoids or retinol equivalents) include: Sweet Potato, Carrots, Winter Squash, Spinach, Kale, Turnip Greens, Collard Greens, Beet Greens, Swiss Chard, Shrimp, Eggs, Salmon, Sardines, Tuna

B Vitamins are not directly involved in the bone building process but are important because of their role in energy metabolism:

Vitamin B6 (pyridoxine) is an enzyme reaction cofactor.

Foods rich in vitamin B6 include: Potatoes, Sunflower Seeds, Spinach, Banana, Cabbage, Collards, Kale, Cauliflower, Brussels Sprouts, Tuna, Turkey, Beef, Chicken, Salmon

Vitamin B9 (Folic Acid) is an enzyme reaction cofactor.

Foods rich in Folic Acid includeLentils, Beans, Asparagus, Romaine Lettuce, Bok Choy, Spinach, Turnip Greens, Broccoli, Beets, Cauliflower, Parsley

Vitamin B12 is a cofactor for bone building proteins and is involved in iron metabolism.

Foods rich in vitamin B12 include: Sardines, Salmon, Tuna, Cod, Lamb, Scallops, Shrimp, Beef, Turkey, Chicken, Yogurt, Milk, Eggs, Cheese, Cremini Mushrooms, Fortified Foods

Make changes to your diet and physical activity level to support your bones… because they support you! 💪🏻



  • National Osteoporosis Foundation  Accessed April 25, 2015
  • Zikan V. Bone health in patients with multiple sclerosis. J Osteoporos. 2011;2011:596294. doi: 10.4061/2011/596294. Epub 2011 Mar 30
  • Dobson R, Ramagopalan S, Giovannoni G. Bone health and multiple sclerosis.Mult Scler. 2012 Nov;18(11):1522-8. doi: 10.1177/1352458512453362. Epub 2012 Jun 27.
  • Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-8.


I am a Registered Dietitian Nutritionist living in Greensboro, North Carolina. I help people overcome nutrition obstacles and help them meet their nutrition and wellness goals.

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Hi, I’m Mona. I have been living with Relapsing Remitting Multiple Sclerosis (RRMS) for over ten years. As a registered dietitian nutritionist (RDN) I help others with MS to navigate the nutrition superhighway and make sustainable progress toward their unique wellness goals.

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